Relapse prevention therapy

Much of the above is also part of 'relapse prevention therapy'.(1 l3 In this therapy patients are shown how to analyse and modify the causes of relapse. They are helped to identify 'seemingly irrelevant decisions', in which a sequence that ended in drinking began with apparently unconnected actions. For example, the person chooses to stop at the supermarket to buy fruit, knowing that there is plenty at home already, and comes out with a bottle of wine. The patient is encouraged to identify seemingly irrelevant decisions, and, by recording thoughts and feelings during the days between therapy sessions, to map out risky emotional or environmental situations and to prepare avoidance and coping tactics. By logging success they can build up their sense of mastery.

Relapse may be preceded by a feeling of deserving a drink or of being deprived. Helping the patient to have more satisfaction in other areas of life helps combat these feelings.

Patients are educated about the abstinence violation effect. The suggestion is that a patient who made a strong commitment to abstain, but has taken one drink, is overcome by a sense of failure and counters this by thinking, for example, 'This shows I'm just a drunk after all!'s—which leads to further consumption. The abstinence violation effect predicts that relapse after taking a single drink would be most frequent in those with the strongest resolution to abstain. However, research has found that greater commitment is associated with less risk of relapse after a single lapse.(30) Nevertheless, it seems helpful to prepare patients for a lapse, and to avoid catastrophic thinking.

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